Ongoing CPR with an onboard physician.

Introduction: Recent data are not available on ongoing CPR for emergency services with an onboard physician. The aim of the present study was to identify factors associated with the decision to transport patients to hospital with ongoing CPR and examine their survival to hospital discharge with good neurological status. Methods: An observational study based on a registry of out-of-hospital cardiac arrests attended to by emergency services with an onboard physician. All OHCA cases occurring between the 1st of January and the 31st of December 2022 were included. Patients receiving ongoing CPR during transport to the hospital were compared with patients pronounced dead at the scene following arrival of the care team. The dependent variable was ongoing CPR during transport to the hospital. The main characteristics and the neurological status of patients surviving to discharge were described. Results: A total of 9321 cases were included, of which 350 (3.7%) were transported to hospital with ongoing CPR. Such patients were young (59.9 ± 20.1 years vs 64.6 ± 16.9 years; p < 0.001; 95%CI: 0.98 [0.98; 0.99]) with arrest taking place outside of the home (151 [44.5%] vs 4045 [68.01%]; p < 0.001; 95%CI: 0.41 [0.31; 0.54]) and being witnessed by EMS (126 [36.0%] vs 667 [11.0%]; p < 0.001; 95%CI: 4.31 [3.19; 5.80]), whilst initial rhythm differed from asystole (164 [47.6%] vs 4325 [73.0%]; p < 0.01; 95%CI: 0.44 [0.33; 0.60]) and a mechanical device was more often employed during resuscitation and transport to hospital (199 [56.9%] vs 2050 [33.8%]; p < 0.001; 95%CI: 2.75 [2.10; 3.59]). Seven patients (2%) were discharged alive from hospital, five with ad integrum neurological recovery (CPC1) and two with minimally impaired neurological function (CPC2). Conclusions: The strategy of ongoing CPR is uncommon in EMS with an onboard physician. Despite their limited efficacy, the availability of mechanical chest compression devices, together with the possibility of specific hospital treatments, mainly ICP and ECMO, opens up the possibility of this approach with determined patients.

Use of a structural deformity index as a predictor of severity among trauma victims in motor vehicle crashes.

BACKGROUND: Information obtained from vehicle crash scenes, called kinematics, may prove useful in the management of victims and may complement anatomical and physiological findings. OBJECTIVES: In addition to analyzing the significance of age, gender, position occupied in the vehicle, the use of restraint systems, and ejection from the vehicle, the objective was to carry out a preliminary study of what we have defined as the Structural Deformity Index (SDI) to verify its usefulness in predicting injury severity at the scene of a motor vehicle crash. The index consists of various parameters that can be easily identified at the crash scene. METHOD: An historical cohort of vehicle occupants involved in crashes in the Navarra province of Spain from January 1, 2001 to December 31, 2002 was studied. Information was collected from the database of the Navarra Severe Trauma Victim group study. Bivariate statistical analysis and multivariate logistic regression models were employed for statistical management. RESULTS: There were 212 vehicle occupants identified. Significant differences in severity of injury, and of mortality, were observed based on age, ejection from the vehicle, and a high SDI. Logistic regression showed significant differences in injury severity by age (odds ratio [OR] 6.55, 95% confidence interval [CI] 1.6-26.7) and high SDI (OR 1.84, 95% CI 1-3.3), as well as differences in the patient death rate by age (OR 6.92, 95% CI 1.2-38.9) and high SDI (OR 3.28, 95% CI 1.5-6.8). CONCLUSIONS: The SDI is useful to the first responders, enabling them to alert and transmit objective, reliable information to the emergency coordination center, thus efficiently activating health care resources. In addition, use of the SDI may assist prehospital and hospital health care providers to suspect the presence of particular serious injuries when anatomical and physiological criteria are not definitive.

Comparison of mortality due to severe multiple trauma in two comprehensive models of emergency care: Atlantic Pyrenees (France) and Navarra (Spain).

BACKGROUND: Injury due to external causes is an important health problem in our society today. Emergency care systems based on the concept of "comprehensive care" can prevent deaths and disabilities as well as limit the severity and pain caused by trauma. OBJECTIVE: To investigate the frequency and characteristics of different mechanisms of injury and to estimate mortality, comparing two comprehensive emergency systems: Atlantic Pyrenees (AP) in France and Navarra (NA) in Spain. MATERIAL AND METHODS: A prospective cohort study of severe multiple-injury patients attended to by the comprehensive emergency care systems of AP and NA from April 1, 2001 to March 31, 2002. Data were collected from personal patient data, the emergency coordination center "112," pre-hospital and hospital health care levels, and discharge data. Bivariate statistical analysis and multivariate logistic regression models were employed for statistical management. RESULTS: There were 614 severe multiple trauma patients recorded, 278 in AP and 336 in NA. Significant differences were observed in arrival time, pre-hospitalization care, pre-hospital Revised Trauma Score (RTS), Injury Severity Score (ISS) at the intensive care unit, and procedures used (intubation, administration of fluids, immobilization, and diagnostic methods). Logistic regression showed significant differences in patient death, age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.03), penetrating or accidental injuries, (OR 3.85, 95% CI 1.1-13.1), RTS (OR 0.58, 95% CI 0.5-0.7), and ISS score (OR 1.05, 95% CI 1.0-1.1). CONCLUSION: Despite a more aggressive approach and employment of greater resources, the French comprehensive trauma system does not show greater survival rates among injured patients compared to Navarra, even when controlling for confounding factors like age, injury mechanism, RTS, ISS, and others.